| NPI | 1720500606 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 6590-C1) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60755132) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2019-05-14 |