| NPI | 1811422421 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 103438) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D010163) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2019-04-18 |