| NPI | 1568613362 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2011026139) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 55084) |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2020-03-03 |