| NPI | 1710026059 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 57698) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS036911) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2022-07-20 |