| NPI | 1093727810 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE7055) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D5989) |
| 122300000X Dentist (Licence: CA 35892) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2011-04-14 |