| NPI | 1902178312 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 33075) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401006876) |
| Enumeration Date | 2012-01-31 |
| Last Update Date | 2012-01-31 |