NPI | 1184163743 |
---|---|
Former Name | ELIZABETH MARIE STANKO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: WA DR60757624) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2017-02-15 |
Last Update Date | 2022-04-29 |