| NPI | 1346741352 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 102304) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415845) |
| Enumeration Date | 2018-02-25 |
| Last Update Date | 2019-10-01 |