| NPI | 1669112041 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 111640) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 111640) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 13412) | |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2025-08-11 |