| NPI | 1609914399 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60222963) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN17533) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2011-07-22 |