| NPI | 1396191268 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0411000065) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60757254) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2022-07-27 |