| NPI | 1962916981 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60791888) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60791888) |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2017-11-29 |