| NPI | 1245643154 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 64449) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 29878) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2021-09-23 |