| NPI | 1053860049 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D009978) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 100929) |
| Enumeration Date | 2016-10-01 |
| Last Update Date | 2018-05-02 |