| NPI | 1770142705 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61291968) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D11631) |
| 1223G0001X Dentist, General Practice (Licence: OR D11631) | |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2024-08-21 |