| NPI | 1104246925 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D13572) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60672742) |
| Enumeration Date | 2014-04-19 |
| Last Update Date | 2019-09-05 |