| NPI | 1871564476 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 17114) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WA DE00008269) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2007-07-08 |