| NPI | 1699345694 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 14005) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401417538) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2025-01-31 |