| NPI | 1740897545 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61088084) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D11345) |
| Enumeration Date | 2020-09-25 |
| Last Update Date | 2023-09-26 |