| NPI | 1104472802 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA DDS105249) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ DI02771700) |
| Enumeration Date | 2019-08-18 |
| Last Update Date | 2020-11-05 |