| NPI | 1891047973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 100280) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS039113) |
| 1223P0300X Dentist, Periodontics (Licence: CA 100280) | |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2016-11-10 |