| NPI | 1841643640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN25756) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60658594) |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2022-11-01 |