| NPI | 1053684431 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 64019) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 64019) |
| 1223G0001X Dentist, General Practice (Licence: IL 019028927) | |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2018-06-28 |