| NPI | 1821467655 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 64872) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022148) |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2020-02-29 |