| NPI | 1164079638 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13798) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 104202) |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2024-08-06 |