| NPI | 1780837625 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 3461) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 48511) |
| 122300000X Dentist (Licence: VA 0401410647) | |
| 122300000X Dentist (Licence: NC 8719) | |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2011-06-01 |