| NPI | 1659578961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 00007477) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 7477) |
| 122300000X Dentist (Licence: WA DE00007477) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2019-05-14 |