| NPI | 1629285705 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 35439) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 35439) |
| 122300000X Dentist (Licence: HI 1523) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2022-01-31 |