| NPI | 1194340612 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61439564) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WI 1002296) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2024-01-02 |