| NPI | 1922451392 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60900883) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 100288) |
| 1223G0001X Dentist General Practice (Licence: OR D11414) | |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2022-07-20 |