| NPI | 1578764882 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60226224) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D12391) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2013-01-26 |