| NPI | 1861600124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 58146) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 17) |
| 1223G0001X Dentist, General Practice (Licence: CA 58146) | |
| 1223G0001X Dentist, General Practice (Licence: FL DN 17) | |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2017-08-21 |