| NPI | 1881973774 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN015273) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 055707) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2016-08-29 |