| NPI | 1982076519 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 102469) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 16147) |
| 122300000X Dentist (Licence: DC DEN1001617) | |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2018-09-07 |