| NPI | 1942517784 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 100694) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401412985) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2018-03-17 |