| NPI | 1821646134 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 38366) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60979247) |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2022-06-03 |