| NPI | 1780238741 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60830423) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WA DE60830423) |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2024-12-12 |