| NPI | 1649695453 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 47717) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 47717) |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2021-08-02 |