| NPI | 1316317852 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 105561) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415035) |
| Enumeration Date | 2015-09-27 |
| Last Update Date | 2020-12-28 |