| NPI | 1679709448 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 60409721) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412479) |
| 1223G0001X Dentist, General Practice (Licence: WA 60409721) | |
| Enumeration Date | 2009-06-06 |
| Last Update Date | 2019-01-05 |