| NPI | 1053954156 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 104359) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 104359) |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2022-03-01 |