| NPI | 1386042166 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 64212) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414582) |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2015-08-03 |