| NPI | 1356624175 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: CA DDS102257) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: PA DS040069) |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2018-11-25 |