| NPI | 1073526794 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 54005) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 055807-1) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2014-04-22 |