| NPI | 1174081251 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IA 10182) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 10182) |
| 122300000X Dentist (Licence: WA DE61137466) | |
| 122300000X Dentist (Licence: OH 30.026068) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.026068) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE61137466) | |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2024-04-03 |