| NPI | 1043422520 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 55174) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 5100) |
| 1223G0001X Dentist, General Practice (Licence: PA DS036880) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2019-09-05 |