| NPI | 1467772459 |
|---|---|
| Former Name | DANIELA ROSE-MARIE ELLISON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NM DD2323) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 36240) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2010-06-02 |