| NPI | 1962566414 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 46241) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 46241) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2022-05-04 |