| NPI | 1831251958 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE9896) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WA DE9896) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2007-07-08 |