| NPI | 1972918191 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60945290) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 30126) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2026-02-24 |