| NPI | 1619134939 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA de00010280) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00010280) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2009-08-15 |