| NPI | 1154675155 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 65269) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60307748) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2018-07-16 |