| NPI | 1295473619 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS111457) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859404) |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2025-12-17 |