| NPI | 1417315490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60657443) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA RR 60576274) |
| 125Q00000X Oral Medicine (Licence: WA DE60657443) | |
| Enumeration Date | 2016-02-04 |
| Last Update Date | 2024-05-21 |