| NPI | 1356721229 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60598746) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61172) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2021-11-10 |