| NPI | 1346852498 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61569916) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 36606) |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2025-04-01 |