| NPI | 1861053613 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV LL-554-21) |
| 122300000X Dentist (Licence: ID D-5154) | |
| 122300000X Dentist (Licence: WA DE60962154) | |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2021-07-02 |