| NPI | 1669733390 |
|---|---|
| Former Name | HEATHER NICOLE DELASALLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 7659) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MS PTA4741) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2025-09-02 |