| NPI | 1790156131 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 16623) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 65137) |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2021-01-27 |