| NPI | 1548612039 |
|---|---|
| Former Name | NICOLETTE HOLLY BOHN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60659495) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60659495) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2023-11-30 |