| NPI | 1700456183 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401418451) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0442000433) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2026-07-21 |