| NPI | 1780425843 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN123955) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-10423) |
| 122300000X Dentist (Licence: FL DN30947) | |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2026-03-22 |