| NPI | 1942675723 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN122784) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60865949) |
| 1223D0001X Dentist, Dental Public Health (Licence: WA DE60865949) | |
| 1223G0001X Dentist, General Practice (Licence: CA 65134) | |
| Enumeration Date | 2015-12-05 |
| Last Update Date | 2022-12-13 |