| NPI | 1104233774 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 60473159) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 63519) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2014-10-22 |