| NPI | 1902458680 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS104717) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1002155) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2022-08-23 |