| NPI | 1740633171 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AK 110367) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 60652740) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2022-07-21 |