| NPI | 1124660113 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PR 3362) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 3362) |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2022-12-09 |