| NPI | 1730410051 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 58525) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 58525) |
| Enumeration Date | 2010-01-26 |
| Last Update Date | 2017-10-26 |