| NPI | 1568985604 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA DE60760770) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ID D4861) |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2018-10-21 |