| NPI | 1134737505 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61474642) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858758) |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2023-10-18 |