| NPI | 1811507320 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 105274) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 36302) |
| 1223G0001X Dentist, General Practice (Licence: CA 105274) | |
| Enumeration Date | 2020-08-09 |
| Last Update Date | 2023-10-06 |