| NPI | 1255681219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 102190) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE 60302794) |
| 122300000X Dentist (Licence: OR D9789) | |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2021-10-23 |