| NPI | 1003122748 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA Not yet issued) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 6317) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2014-12-08 |