| NPI | 1376805556 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: WA 60852892) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414116) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2025-07-27 |