| NPI | 1396331021 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA 61030822) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 36929) |
| Enumeration Date | 2020-12-16 |
| Last Update Date | 2022-04-13 |