| NPI | 1104177484 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60379960) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60379960) |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2024-07-02 |