| NPI | 1194196675 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401419273) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 65104) |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2025-05-01 |