| NPI | 1396477758 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 111205) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10822) |
| Enumeration Date | 2022-06-25 |
| Last Update Date | 2025-06-23 |