| NPI | 1720760416 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61479749) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D11864) |
| Enumeration Date | 2023-08-02 |
| Last Update Date | 2023-10-11 |