| NPI | 1932453198 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 56236) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: ID D-4893-PE) |
| 1223P0300X Dentist, Periodontics (Licence: NV S4-111C) | |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2019-08-16 |