| NPI | 1104112390 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA CA63169) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038796) |
| Enumeration Date | 2011-06-26 |
| Last Update Date | 2022-01-06 |