| NPI | 1215669718 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 8437177) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 559509) |
| Enumeration Date | 2022-06-24 |
| Last Update Date | 2022-06-24 |