| NPI | 1720064603 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 58616) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901018183) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2015-02-19 |