| NPI | 1972732097 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 100387) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855381) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2022-04-14 |