| NPI | 1619488665 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 103162) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60796142) |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2018-09-04 |