| NPI | 1639395957 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 6699) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 55468) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2010-09-21 |