| NPI | 1073599957 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA DDS53184) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 53184) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2017-08-30 |