| NPI | 1396930517 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 61540) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00011089) |
| 122300000X Dentist (Licence: ID D-4667) | |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2015-12-23 |