| NPI | 1336475706 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 9905) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE 60105498) |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2015-08-29 |