| NPI | 1902359409 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA 61201886) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WV 4228) |
| 1223G0001X Dentist General Practice (Licence: VA 0401416489) | |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2022-03-15 |