| NPI | 1578153623 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS108609) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204630) |
| Enumeration Date | 2021-01-22 |
| Last Update Date | 2023-03-24 |