| NPI | 1114571262 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 61069937) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032278) |
| Enumeration Date | 2019-07-27 |
| Last Update Date | 2023-12-13 |