| NPI | 1649648668 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: AZ 10316) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD4368) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2024-01-19 |