| NPI | 1407521420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 108686) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS043317) |
| Enumeration Date | 2021-08-11 |
| Last Update Date | 2023-11-08 |