| NPI | 1689097990 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE 60389264) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D10767) |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2020-01-23 |