| NPI | 1205240926 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401416930) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL12241) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2021-03-29 |