| NPI | 1780163220 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS109426) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022793) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2023-11-16 |