| NPI | 1902165202 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 100183) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 100183) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2020-04-14 |