| NPI | 1063871853 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 102421) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D009709) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2019-08-01 |