| NPI | 1902543101 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401418794) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA pending) |
| 122300000X Dentist (Licence: VA 0442000448) | |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2024-07-10 |