| NPI | 1679246888 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0442000502) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 106648) |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2023-08-02 |