| NPI | 1831596857 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 64352) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60482837) |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2015-10-23 |