| NPI | 1740663715 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 6569) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 6569) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2025-07-21 |