| NPI | 1710007521 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60034752) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN17851) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2022-06-03 |