| NPI | 1720717275 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 7579) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 39273) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2024-09-12 |