| NPI | 1861709412 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA DDS65262) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901020174) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2017-04-25 |