| NPI | 1295275642 |
|---|---|
| Former Name | MIKAELA GOODMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103748) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2024-05-30 |