| NPI | 1518942432 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 105130) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8212) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2020-08-14 |