| NPI | 1790262079 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN123053) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 12264) |
| 122300000X Dentist (Licence: DC DEN2000027) | |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2023-05-31 |