| NPI | 1487020772 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D009357) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 65008) |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2015-11-10 |