| NPI | 1154423259 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA 00010429) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE10429) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2022-07-21 |