| NPI | 1033466628 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60257370) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D7581) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2012-08-14 |