| NPI | 1235701053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61178265) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE61178265) |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2022-12-07 |