| NPI | 1366883514 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 101257) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: CA 101257) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2022-10-12 |