| NPI | 1356782080 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA DDS62530) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA DDS62530) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2024-02-14 |