| NPI | 1366773079 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60018757) | 
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: WA DE60018757) | 
| Enumeration Date | 2010-01-20 | 
| Last Update Date | 2010-01-20 |