| NPI | 1518262849 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 29126) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60333315) |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2021-01-26 |