| NPI | 1225619398 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 108305) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61142655) |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2022-10-21 |