| NPI | 1750413209 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE00010441) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WA TR60082310) |
| Enumeration Date | 2007-03-11 |
| Last Update Date | 2012-01-19 |