| NPI | 1144550773 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60135332) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 58977) |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2022-10-11 |