| NPI | 1932921822 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 41150) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61572279) |
| Enumeration Date | 2024-10-30 |
| Last Update Date | 2025-04-15 |