| NPI | 1699175620 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D10130) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60496474) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2018-10-01 |