| NPI | 1356533541 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 59222) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MI 2901019187) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2014-11-04 |