| NPI | 1144602608 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 103714) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021605) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2019-10-30 |