| NPI | 1679957245 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60675630) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA RR60564898) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2016-09-29 |