| NPI | 1750823951 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60693244) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041112) |
| Enumeration Date | 2016-11-06 |
| Last Update Date | 2018-06-26 |