| NPI | 1841715653 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61027275) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 7410) |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2024-06-27 |