| NPI | 1215602479 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS110815) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D11499) |
| Enumeration Date | 2021-08-10 |
| Last Update Date | 2026-06-12 |