| NPI | 1104109289 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA dds61201) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412973) |
| Enumeration Date | 2011-09-24 |
| Last Update Date | 2023-06-01 |