| NPI | 1548318991 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D8154) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00010070) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-08-10 |