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 |