| NPI | 1700057213 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE00008629) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D4584) |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2008-03-13 |