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 |