| NPI | 1003499245 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401417774) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN2000128) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901603248) | |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2026-07-30 |