| NPI | 1124540828 |
|---|---|
| Former Name | ERICA JANE WALTERS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 4605) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 4605) |
| 1223D0001X Dentist, Dental Public Health (Licence: MN D14097) | |
| 1223G0001X Dentist, General Practice (Licence: MN D14097) | |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2022-06-21 |