| NPI | 1073356267 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 14878) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC DGD.10835) |
| Enumeration Date | 2024-06-14 |
| Last Update Date | 2026-07-22 |