| NPI | 1770535148 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 50854) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 7268) |
| 122300000X Dentist (Licence: PA DS023017L) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2011-12-16 |