| NPI | 1609353747 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60879436) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN23357) |
| Enumeration Date | 2018-07-22 |
| Last Update Date | 2018-08-24 |