| NPI | 1609062801 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 56342) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056031) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2019-07-22 |