NPI | 1679017479 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 100363) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 100363) |
Enumeration Date | 2016-12-13 |
Last Update Date | 2020-10-22 |