| NPI | 1508489238 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE61242262) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN24876) |
| 122300000X Dentist (Licence: WA DE61242262) | |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2022-04-13 |