| NPI | 1043729361 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 12959) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857764) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 37125) | |
| Enumeration Date | 2017-09-29 |
| Last Update Date | 2022-08-15 |