| NPI | 1790136232 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA DDS108098) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040906) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2022-10-21 |