| 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 |