| NPI | 1558510255 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 25305) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 25305) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 25305) | |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2022-08-29 |