| NPI | 1225440662 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D011130) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WA CG60460804) |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2021-08-25 |