| NPI | 1467943019 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 60949816) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6856) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2019-07-23 |