| NPI | 1760933899 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61295550) |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: WA D1 60580186) |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2022-06-30 |