| NPI | 1477962330 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 62285) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA 60725851) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2018-09-05 |