| NPI | 1477989945 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60991189) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 9760) |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2023-04-06 |