| NPI | 1487175907 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60960113) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 10587) |
| 122300000X Dentist (Licence: WA DF60976684) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: WA DR60847532) | |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2022-04-15 |