| NPI | 1760856512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL 24946) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 65145) |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2020-10-22 |