| NPI | 1821209297 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401411787) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: WA DE60591198) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2022-07-21 |