| NPI | 1285860650 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE 60144995) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS037903) |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2016-06-07 |