| NPI | 1437532579 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 260181) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 32737) |
| 122300000X Dentist (Licence: VA 0401415517) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401415517) | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2022-03-31 |