| NPI | 1003339375 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA DE60969822) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D10672) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2023-08-02 |