| NPI | 1417110669 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 59408) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA 22211) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2024-05-09 |