NPI | 1053613968 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 59904) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 59904) |
122300000X Dentist (Licence: PA 038516) | |
1223G0001X Dentist, General Practice (Licence: CO DEN10345) | |
Enumeration Date | 2010-11-29 |
Last Update Date | 2018-03-28 |