| NPI | 1972115210 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: LA 7354) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA TP61089701) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: LA 7354) | |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2023-02-14 |