| NPI | 1053778241 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 65123) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 65123) |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2023-07-31 |