| NPI | 1184877482 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CT 11337) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57829) |
| Enumeration Date | 2008-10-30 |
| Last Update Date | 2015-02-03 |