| NPI | 1801294301 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA DDS103440) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA ds040113) |
| Enumeration Date | 2014-12-15 |
| Last Update Date | 2019-07-15 |