| NPI | 1104276104 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 101515) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61165) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2019-09-10 |