| NPI | 1770706780 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 56534) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: RI LD00015) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2015-03-09 |