| NPI | 1245536804 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 58660) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 58660c) |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2014-03-14 |