| NPI | 1881118982 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11256) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS101332) |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2021-03-29 |