| NPI | 1053154450 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 41325) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61556984) |
| Enumeration Date | 2024-06-14 |
| Last Update Date | 2025-06-02 |