| NPI | 1114313566 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 105831) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057374) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2022-07-13 |