| NPI | 1083632376 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 45110) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 45110) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2015-12-22 |