| NPI | 1902031586 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 8784) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60429148) |
| 1223G0001X Dentist, General Practice (Licence: WA DE60429148) | |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2025-08-13 |