| NPI | 1649626672 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901601227) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60751092) |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2022-07-28 |