| NPI | 1679988547 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 64283) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 6625) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2015-04-06 |