| NPI | 1205386612 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 65083) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN22199) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2022-02-02 |