| NPI | 1972816353 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 105591) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401413888) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2021-03-18 |