NPI | 1376975375 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA DDS106220) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE60402382) |
Enumeration Date | 2013-08-01 |
Last Update Date | 2021-10-26 |