| NPI | 1366549727 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM 1438) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 7274) |
| 122300000X Dentist (Licence: WA DE00005243) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2016-06-21 |