| NPI | 1053650655 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 54613) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FL RDH11724) |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2022-09-27 |