| NPI | 1508966276 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60350525) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 60350525) |
| 1223G0001X Dentist, General Practice (Licence: CO 9036) | |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2022-11-08 |