| NPI | 1811159247 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD3275) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 54839) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2020-07-22 |