| NPI | 1003229311 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D10841) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 29964) |
| 122300000X Dentist (Licence: OR D10841) | |
| 1223G0001X Dentist, General Practice (Licence: TX 29964) | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2021-02-09 |