| NPI | 1659094902 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0008X Dentist Oral and Maxillofacial Radiology (Licence: TX 39285) |
| Additional Taxonomies | 1223X0008X Dentist Oral and Maxillofacial Radiology (Licence: WA DE61353037) |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2023-03-14 |