NPI | 1558383034 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 63238) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NH 3042) |
1223G0001X Dentist, General Practice (Licence: MA 18978) | |
Enumeration Date | 2006-07-24 |
Last Update Date | 2021-10-06 |