| NPI | 1235270604 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE00005170) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 26847) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2007-07-08 |