| NPI | 1861869505 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 100789) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414961) |
| Enumeration Date | 2015-08-28 |
| Last Update Date | 2022-07-21 |