| NPI | 1154644235 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60139656) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DR60093508) |
| Enumeration Date | 2010-03-03 |
| Last Update Date | 2016-01-22 |