| NPI | 1598102790 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 62249) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62249) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2022-08-25 |