| NPI | 1902368848 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MD 16993) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 16993) |
| 122300000X Dentist (Licence: VA 0401416559) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2021-07-02 |