| NPI | 1457581159 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 63586) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 7829) |
| 122300000X Dentist (Licence: CO 202059) | |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2015-07-02 |