| NPI | 1720214059 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D7840) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61395735) |
| 1223G0001X Dentist, General Practice (Licence: WA DE61395735) | |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2025-02-21 |