| NPI | 1093281156 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103471) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401416312) |
| Enumeration Date | 2018-10-16 |
| Last Update Date | 2019-01-12 |