| NPI | 1902087737 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 56693) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901018985) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2009-08-07 |