| NPI | 1548037567 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 40734) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60658516) |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2024-09-05 |