| NPI | 1396147807 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 107342) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 011191) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2022-06-29 |