| NPI | 1790422970 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS110185) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859483) |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2024-09-18 |