| NPI | 1841453792 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN014764) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 5954) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2014-08-12 |