| NPI | 1588298939 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: CA 104614) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 104614) |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2023-07-04 |