| NPI | 1235452368 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 59203) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60168085) |
| Enumeration Date | 2010-03-03 |
| Last Update Date | 2016-01-28 |