| NPI | 1881827921 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 10391199) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57663) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2017-10-31 |