| NPI | 1205114097 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019.029363) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 103420) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901020375) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 103420) | |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2022-08-11 |