| NPI | 1992193510 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D10172) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60535003) |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2016-07-12 |