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 |