| NPI | 1790032076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401415256) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62515) |
| 1223G0001X Dentist, General Practice (Licence: NV 6306) | |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2018-03-17 |