| NPI | 1376021451 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61358342) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-09591) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2023-02-15 |