| NPI | 1336751098 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DRPM2607) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS105254) |
| Enumeration Date | 2020-08-23 |
| Last Update Date | 2023-07-20 |