| NPI | 1508027285 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 55799) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 55799) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2014-04-28 |