| NPI | 1386154359 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60792632) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60792632) |
| Enumeration Date | 2017-10-04 |
| Last Update Date | 2020-09-18 |