| NPI | 1063297703 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS111840) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 13468651-9921) |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2026-03-04 |