| NPI | 1790504033 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN31128) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS109716) |
| Enumeration Date | 2024-10-04 |
| Last Update Date | 2026-01-21 |