| NPI | 1720374887 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 100797) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401413252) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2022-07-21 |