| NPI | 1811580004 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: CA 294) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: WA DE61449145) |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2023-10-23 |