| NPI | 1174737803 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA de00010535) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8180) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2013-08-21 |