| NPI | 1447796636 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 104703) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 6866) |
| Enumeration Date | 2017-01-11 |
| Last Update Date | 2020-08-13 |