| NPI | 1356819403 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61014597) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858180) |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2019-12-23 |