| NPI | 1679703375 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 64240) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D12730) |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2022-02-11 |