| NPI | 1396306585 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61193243) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA DN1858416) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2022-10-25 |