| NPI | 1861505984 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 40116) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 4972) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2007-07-08 |