| NPI | 1295405025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61387262) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 37815) |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2023-03-09 |