| NPI | 1558872978 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA 60662094) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 60662094) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2018-06-27 |