| NPI | 1235464223 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60167264) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 03747) |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2021-09-03 |