| NPI | 1649419854 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 56185) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 56185) |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2019-10-21 |