| NPI | 1679829543 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D10811) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60611585) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2024-04-17 |