| NPI | 1174262117 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 107234) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 107234) |
| Enumeration Date | 2022-05-28 |
| Last Update Date | 2024-10-26 |