| NPI | 1063733822 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60139644) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60139644) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2021-03-30 |