| NPI | 1578329652 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401419931) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61577761) |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2026-05-01 |