| NPI | 1770129926 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 104212) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 104212) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| 1223X2210X Dentist, Orofacial Pain (Licence: CA 104212) | |
| 1223P0300X Dentist, Periodontics (Licence: CA 104212) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 104212) | |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2026-03-03 |