| NPI | 1386010866 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 60684370) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 31390) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2016-11-09 |