| NPI | 1356678031 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 58531) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054448) |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2016-07-26 |