| NPI | 1700191202 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 64929) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: CA 25146) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D14112) | |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2024-06-12 |