| NPI | 1336556372 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60559889) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 30296) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2020-06-27 |