| NPI | 1699965418 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 495) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 3152) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2025-12-11 |