| NPI | 1336523935 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS101952) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040537) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2021-06-04 |