| NPI | 1902068372 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN014359) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 22194) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2015-11-23 |