| NPI | 1851302392 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN009385) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN009385) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2007-07-08 |