| NPI | 1659500908 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 64441) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL06688) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2017-03-16 |