| NPI | 1700297249 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 63404) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NV S4-106) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2019-11-21 |