| NPI | 1093393258 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61268684) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DR61164812) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2023-01-17 |