| NPI | 1801872114 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA 10450) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00010450) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2014-12-15 |