| NPI | 1831611573 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61077413) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 101520) |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2021-08-20 |