| NPI | 1649583931 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD LL609) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 59445) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2013-07-31 |