| NPI | 1366576704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE00008096) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 32587) |
| 1223G0001X Dentist, General Practice (Licence: WA 8096) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2014-04-24 |