| NPI | 1366726176 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA DE60237121) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D9650) |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2018-03-17 |