| NPI | 1841817574 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61146983) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-5170) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2021-05-18 |