| NPI | 1841475761 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 14543) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 56483) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2025-10-05 |