| NPI | 1316316706 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 64894) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 7062) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2020-09-14 |