| NPI | 1053096222 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61264294) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE61264294) |
| 1223X2210X Dentist, Orofacial Pain (Licence: WA DE61264294) | |
| Enumeration Date | 2023-06-16 |
| Last Update Date | 2024-10-28 |