| NPI | 1396123030 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE.61045280) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 9245) |
| 122300000X Dentist (Licence: CA 65090) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D11196) | |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2020-05-13 |