| NPI | 1760756837 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE 00010387) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D8339) |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2012-03-06 |