| NPI | 1982159042 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN015045) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 100575) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2016-09-19 |