| NPI | 1639578826 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS104748) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00202337) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2020-02-27 |