| NPI | 1740855618 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD5477) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS108665) |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2026-04-13 |