| NPI | 1629332846 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60844321) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 27992) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 27992) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2022-08-10 |