| NPI | 1548785181 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857715) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL Dn25648) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 38154) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-08-04 |
| Last Update Date | 2022-07-05 |