| NPI | 1497064117 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 25999) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WA DE60170226) |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2018-10-29 |