| NPI | 1770198806 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE70040875) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE70040875) |
| 1223G0001X Dentist, General Practice (Licence: CT 12907) | |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2026-03-30 |