| NPI | 1891104584 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60755446) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 30376) |
| 1223G0001X Dentist, General Practice (Licence: FL DN 20660) | |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2024-01-25 |