| NPI | 1003936501 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: WA D10078) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: OR D7318) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2007-07-08 |