| NPI | 1902329402 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS102378) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041285) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2021-05-13 |