| NPI | 1720071160 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 53543) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D10361) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2007-07-08 |