| NPI | 1376825505 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61483486) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 25534) |
| 1223G0001X Dentist, General Practice (Licence: OR D9617) | |
| 1223G0001X Dentist, General Practice (Licence: CA DDS101470) | |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2024-07-02 |