| NPI | 1912292905 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA D11422) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA d11422) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2011-06-17 |