| NPI | 1629319892 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 00203700) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 057587) |
| Enumeration Date | 2013-03-12 |
| Last Update Date | 2023-04-12 |