| NPI | 1215660717 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 041418851) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2022024401) |
| Enumeration Date | 2022-07-03 |
| Last Update Date | 2024-07-13 |