| NPI | 1972278018 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61252606) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 7764) |
| Enumeration Date | 2021-08-11 |
| Last Update Date | 2025-02-03 |