| NPI | 1891162996 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60900864) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL13366) |
| 122300000X Dentist (Licence: MA DL12690) | |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2023-05-08 |