| NPI | 1669589008 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA DE00010261) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 22769) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2018-09-21 |