| NPI | 1700015146 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D9721) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60105500) |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2016-02-11 |