| 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 |