| NPI | 1750741716 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60732567) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DR60651464) |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2017-03-15 |