| NPI | 1972165736 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61525196) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS103880) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2024-05-28 |