| NPI | 1740726769 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 101136) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 101136) |
| Enumeration Date | 2017-01-14 |
| Last Update Date | 2020-10-13 |