| NPI | 1306490636 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE-61085991) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 104139) |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2024-08-07 |