| NPI | 1003273509 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60694716) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D10597) |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2021-12-03 |