| NPI | 1134508971 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60576762) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 62947) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 62947) | |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2015-09-12 |