| NPI | 1124459599 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE603596220) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WA DE603596220) |
| 1223P0300X Dentist Periodontics (Licence: WA DE603596220) | |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2013-12-10 |