| NPI | 1144510686 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D9559) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60203626) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2020-10-08 |