| NPI | 1699176024 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61095620) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 63822) |
| 122300000X Dentist (Licence: MN D13475) | |
| Enumeration Date | 2014-09-04 |
| Last Update Date | 2021-01-12 |