| NPI | 1205291671 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 64688) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 33764) |
| Enumeration Date | 2015-12-29 |
| Last Update Date | 2022-08-01 |