| NPI | 1134357676 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE 60355119) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D12652) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2013-08-13 |