| NPI | 1992964662 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 62004) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 21681) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2016-07-27 |