| NPI | 1528705670 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 13434) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA dds107089) |
| 1223G0001X Dentist, General Practice (Licence: CT 13434) | |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2023-11-20 |