| NPI | 1154690196 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS104187) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN19594) |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2020-10-28 |