| NPI | 1699153742 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 64538) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039999) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2015-06-08 |