| NPI | 1720312804 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60521019) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 58784) |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2021-09-22 |