NPI | 1720208671 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 55523) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 5315025848) |
Enumeration Date | 2007-04-25 |
Last Update Date | 2007-07-08 |