| NPI | 1114022043 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 63157) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 8397) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2014-04-04 |