| NPI | 1942754676 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 32187) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WA 60786385) |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2018-03-27 |