| NPI | 1528055365 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE00009712) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D6464) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2019-10-29 |