| NPI | 1841659372 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA DN122214) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00202746) |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2021-01-07 |