| NPI | 1861988362 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE61311424) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61311424) |
| Enumeration Date | 2018-07-08 |
| Last Update Date | 2026-05-26 |