| NPI | 1649646852 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401414911) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 64616) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2015-08-11 |