| NPI | 1104436690 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2024026698) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 105212) |
| Enumeration Date | 2020-08-09 |
| Last Update Date | 2024-12-13 |