| NPI | 1780001511 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS101362) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS039935) |
| Enumeration Date | 2014-03-18 |
| Last Update Date | 2018-04-15 |