| NPI | 1538615992 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61169727) |
| Additional Taxonomies | 122300000X Dentist (Licence: RI DEN03303) |
| Enumeration Date | 2016-08-26 |
| Last Update Date | 2021-11-17 |