| NPI | 1790132405 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS100087) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60640137) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2016-05-23 |