| NPI | 1124715362 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN28573) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DRPM2628) |
| Enumeration Date | 2023-04-19 |
| Last Update Date | 2023-09-15 |