| NPI | 1669836409 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61080297) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.024980) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2022-04-11 |