| NPI | 1184358103 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 61515628) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901601297) |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2025-06-26 |