| NPI | 1619427325 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416901) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60672750) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2021-08-25 |