| NPI | 1083892889 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D9109) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00011201) |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2010-07-16 |