| NPI | 1114400389 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416297) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 103239) |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2023-12-19 |