| NPI | 1003219064 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 64110) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60264061) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2015-07-20 |