| NPI | 1003234899 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60470450) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: WA DH00007833) |
| 122300000X Dentist (Licence: WA DE60470450) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2016-06-03 |