| NPI | 1851602551 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 6083) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6083) |
| 1223G0001X Dentist, General Practice (Licence: NV 7280) | |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2021-11-12 |