| NPI | 1053709782 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 64479) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040233) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 64478) | |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2024-04-26 |