| NPI | 1770966871 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60567256) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D010360) |
| 122300000X Dentist (Licence: WA DE60567256) | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2023-07-07 |