| NPI | 1376892810 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 61780) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NM DB-2025-0022) |
| 122300000X Dentist (Licence: NM DB-2025-0022) | |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2025-04-29 |