| 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 |