| NPI | 1578899886 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MT 13545) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MT 13545) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: CA 58811) | |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2021-11-30 |