| NPI | 1255490470 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60085485) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK 1190) |
| 122300000X Dentist (Licence: CA 58065) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2012-06-19 |