| NPI | 1154400596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA 07056) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WA MD00031910) |
| Enumeration Date | 2006-11-05 |
| Last Update Date | 2023-03-07 |