| NPI | 1619123817 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60115108) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 5584) |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2013-06-21 |