| NPI | 1780913764 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60587893) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 15250) |
| Enumeration Date | 2009-12-21 |
| Last Update Date | 2021-07-16 |