| NPI | 1699255281 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA DDS103960) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858094) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2021-07-02 |