| NPI | 1114548914 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA 61178666) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61178666) |
| Enumeration Date | 2020-05-03 |
| Last Update Date | 2024-09-05 |