| NPI | 1518063569 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 58102) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS036927) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2021-01-22 |