| NPI | 1053541763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 59202) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA pending) |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2013-02-05 |