| NPI | 1083840680 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 63399) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 63399) |
| 1223G0001X Dentist, General Practice (Licence: CT 010001) | |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI02403300) | |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2022-01-14 |