| NPI | 1174174882 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 104418) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS104418) |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2019-09-24 |