| NPI | 1295029056 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 64179) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2011015615) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2014-11-13 |