| NPI | 1568582922 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 58126) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS036895) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2017-12-01 |