| NPI | 1457799728 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DR60371551) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 29028) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2024-01-15 |