| NPI | 1275989659 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: CA 63959) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 63959) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2020-03-02 |