NPI | 1750582110 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 42992) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA 19160) |
Enumeration Date | 2007-05-31 |
Last Update Date | 2018-10-22 |