| NPI | 1629527593 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 107235) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TN 11248) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2022-04-05 |