| NPI | 1952781205 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS101200) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 011340) |
| 122300000X Dentist (Licence: CA 101200) | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2021-08-11 |