| NPI | 1912354689 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11822) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA D00150) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2023-08-08 |