| NPI | 1487918793 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OR D9794) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA DE60100282) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2023-04-13 |