| NPI | 1114691862 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901601706) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61185930) |
| Enumeration Date | 2021-08-05 |
| Last Update Date | 2023-10-31 |