| NPI | 1023373156 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE 60351041) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 28085) |
| Enumeration Date | 2012-07-04 |
| Last Update Date | 2019-12-31 |