| NPI | 1790777951 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 53884) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NV 7430) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2021-08-11 |