| NPI | 1164179784 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61435322) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DR61286110) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-03 |
| Last Update Date | 2023-07-11 |