| NPI | 1275110041 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 61219793) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WA 61163825) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2022-04-24 |