| NPI | 1750852166 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2019016619) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA DDS103198) |
| Enumeration Date | 2018-12-10 |
| Last Update Date | 2019-06-18 |