| NPI | 1588340855 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61359429) |
| Additional Taxonomies | 1223X2210X Dentist Orofacial Pain (Licence: WA DE61359429) |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2023-06-22 |