| NPI | 1790137198 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 60738062) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857417) |
| 122300000X Dentist (Licence: CA 100357) | |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2018-03-17 |