NPI | 1235495664 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 842) |
Additional Taxonomies | 122300000X Dentist (Licence: SC 8156) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2012-04-10 |
Last Update Date | 2022-08-25 |