| NPI | 1518148436 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 58100) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 5675) |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2010-07-27 |