| NPI | 1265959605 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 101804) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 101804) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1858080) | |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2022-05-24 |