| NPI | 1962547174 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID 4495) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00006263) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2016-04-06 |