| NPI | 1063665180 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA A110357) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA OMS 90) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 055245) | |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2011-10-19 |