NPI | 1245623743 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN21778) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN21778) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2015-03-09 |
Last Update Date | 2017-02-10 |