| NPI | 1386144764 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 13889) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 061290) |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2024-10-15 |