| 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 |