| NPI | 1720358542 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ D008606) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA DE60182596) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2017-03-21 |