| NPI | 1174190367 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 108870) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS043147) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2025-08-12 |