| NPI | 1023425857 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 103585) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040126) |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2022-06-03 |