| NPI | 1740292200 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 37025) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA 026569L) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2016-04-26 |