| NPI | 1144699471 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 103399) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE 60526116) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2023-01-04 |