| NPI | 1790064707 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA DN014302) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014302) |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2023-08-07 |