| NPI | 1174053110 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN27925) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2023-06-01 |