| NPI | 1851810188 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 108649) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041481) |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2023-09-01 |