| NPI | 1770868382 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN014262) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00202137) |
| 122300000X Dentist (Licence: NM DD4474) | |
| Enumeration Date | 2011-10-14 |
| Last Update Date | 2021-02-02 |