| NPI | 1578965174 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE 60496940) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 9101799922) |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2015-09-15 |