| NPI | 1801458484 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN24353) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL D24353) |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2021-06-29 |