| NPI | 1821511056 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN015456) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY D-00148) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2026-03-18 |