| NPI | 1306225602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 38212) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60635081) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA RR60560221) | |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2022-03-18 |