| NPI | 1164111340 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 108731) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 108731) |
| Enumeration Date | 2023-05-03 |
| Last Update Date | 2024-04-23 |