| NPI | 1023506631 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 101186) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 101186) |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2019-02-21 |