| NPI | 1659589836 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD3052) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 54729) |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2009-08-12 |