| NPI | 1659634194 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 63914) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020689) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2016-02-10 |