| NPI | 1154559490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 64199) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412749) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2015-02-24 |