| NPI | 1487163713 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 102136) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 60737390) |
| Enumeration Date | 2017-09-29 |
| Last Update Date | 2021-01-26 |