| NPI | 1639723778 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D-5076) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS104057) |
| Enumeration Date | 2019-07-26 |
| Last Update Date | 2019-07-26 |