| NPI | 1104055235 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: CA 62032) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: NY 055065-1) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2013-03-03 |