| NPI | 1770789455 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS61128) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN0014223) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: FL DN0014223) | |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2021-04-11 |