| NPI | 1588049514 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 71100742) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 64751) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2022-11-08 |