| NPI | 1174911663 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60680500) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 9250960-9922) |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2016-10-19 |