| NPI | 1063764868 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 62728) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856143) |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2014-11-21 |