| NPI | 1164804654 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 104849) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040474) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2021-02-11 |