| NPI | 1669097143 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 12624) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 12624) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0442000383) | |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2022-07-13 |