| NPI | 1366782740 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 60642900) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 53197) |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2020-07-27 |