| NPI | 1942870183 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OR D11909) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA DE61548777) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2024-08-01 |