| NPI | 1235790189 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 103803) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 103803) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2024-06-10 |