| NPI | 1104209006 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60569487) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60569487) |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2025-04-11 |