| NPI | 1841547932 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AL 5961) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 5961 C1) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2015-10-14 |