| NPI | 1275161101 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61049435) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: WA DE61049435) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2025-10-23 |