| 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 | 2025-04-09 |