| NPI | 1760739379 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN 014898) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 9551) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2014-11-18 |