| NPI | 1801454301 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 28323) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL 19-82733) |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2023-08-05 |