| NPI | 1750722682 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401414033) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9965) |
| 1223G0001X Dentist, General Practice (Licence: WA DE60830459) | |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2022-09-06 |