| NPI | 1265868780 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D11165) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62969) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2020-11-10 |