| NPI | 1396023461 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60970412) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 018-001815) |
| Enumeration Date | 2011-07-23 |
| Last Update Date | 2021-12-01 |