| NPI | 1457969669 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D12023) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 61085507) |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2024-07-03 |