| NPI | 1154629566 |
|---|---|
| Professional Name | NA NA NA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 60119) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 60119) |
| Enumeration Date | 2011-03-09 |
| Last Update Date | 2011-07-11 |