| NPI | 1114520715 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE61363763) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 36706) |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2025-08-20 |