| NPI | 1841699287 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: LA 7257) |
| Additional Taxonomies | 122300000X Dentist (Licence: RI LD00105) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: PA 49204128) | |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2021-08-13 |