| NPI | 1073195756 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 108436) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CT 13324) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2023-05-27 |