| NPI | 1134616675 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN122216) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 9556) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2022-12-01 |