| NPI | 1245645845 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D011164) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 6092) |
| 122300000X Dentist (Licence: NE 7202) | |
| 122300000X Dentist (Licence: IA DDS-09176) | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2024-09-04 |