| NPI | 1346306511 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE 60258242) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA CA51866) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2015-11-12 |