| NPI | 1528447398 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 104145) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 15890) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2019-08-08 |