| NPI | 1043806722 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 105792) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 105792) |
| Enumeration Date | 2020-12-16 |
| Last Update Date | 2024-08-01 |