| NPI | 1720427651 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 64931) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OR D10020) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2016-01-26 |