| NPI | 1104407501 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 107492) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 107492) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2023-06-27 |