| NPI | 1568020238 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 104541) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1002067) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2021-01-30 |