| NPI | 1093193989 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 100096) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 30528) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2016-06-29 |