| NPI | 1255064028 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61270908) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE61270908) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2022-10-28 |