| NPI | 1376954495 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 62540) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8716753-9921) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2024-07-08 |