| NPI | 1578762076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 12416) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014937) |
| 1223G0001X Dentist, General Practice (Licence: DC DEN1000945) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2021-11-22 |