| NPI | 1972603421 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 43450) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 43450) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2012-11-06 |