| NPI | 1609352749 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60991059) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DF11393) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2021-07-15 |