| NPI | 1508197633 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60216393) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D9358) |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2015-05-28 |