| NPI | 1801209044 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60830347) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 058080) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2019-12-19 |