| NPI | 1972964559 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 100361) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 60311422) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2019-12-22 |