| NPI | 1194392126 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0442000423) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: SC 10435) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2024-02-20 |