| NPI | 1063059764 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401416740) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401416740) |
| 1223G0001X Dentist, General Practice (Licence: FL DRPM2037) | |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2022-08-09 |