| NPI | 1417522491 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 108626) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CT 13601) |
| Enumeration Date | 2021-05-23 |
| Last Update Date | 2023-04-26 |