| NPI | 1508553942 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61562710) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE61562710) |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2026-06-15 |