| NPI | 1811106735 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00205044) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 44354) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2024-05-30 |