| NPI | 1548827769 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: OK 125) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS042218) |
| 1223G0001X Dentist General Practice (Licence: OK 7164) | |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2021-07-11 |