| NPI | 1346640257 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60731699) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA RR 60554410) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2020-12-18 |