| NPI | 1659945582 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA DDS-09881) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61255837) |
| Enumeration Date | 2021-05-15 |
| Last Update Date | 2022-01-21 |