| NPI | 1669033593 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 61130674) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 35190) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2021-09-23 |