| NPI | 1265189310 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 000000000) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN27024) |
| Enumeration Date | 2022-03-08 |
| Last Update Date | 2022-06-29 |