| NPI | 1619965050 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 107281) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019-026607) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2022-09-13 |