| NPI | 1073283602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 106960) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901601897) |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2025-01-19 |