| NPI | 1598193658 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AK 1513) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE 60393658) |
| Enumeration Date | 2013-10-28 |
| Last Update Date | 2013-10-28 |