| NPI | 1578000329 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 00204523) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 9596) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901022093) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 34707) | |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2021-01-22 |