| NPI | 1215300942 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60601259) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 35133) |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2022-11-27 |