| NPI | 1235503806 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA DDS65101) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 65101) |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2018-09-20 |