| NPI | 1386620573 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE 60228332) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D8509) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2011-12-09 |