| NPI | 1982088589 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 105832) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV LL-401-15) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-155) | |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2024-08-01 |