| NPI | 1750864013 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.032484) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60801046) |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2020-02-25 |