| NPI | 1962690040 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61051267) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415546) |
| Enumeration Date | 2007-10-14 |
| Last Update Date | 2021-03-01 |