| NPI | 1659886851 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60806282) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 60806282) |
| Enumeration Date | 2017-12-10 |
| Last Update Date | 2017-12-10 |