| NPI | 1659810232 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 00204880) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 060740) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2021-10-01 |