| NPI | 1538565510 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 63288) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 057586) |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2016-10-19 |