| NPI | 1710472717 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60870697) |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: WA D160434347) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2019-09-10 |