| NPI | 1912231333 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 29791) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1855545) |
| 1223G0001X Dentist, General Practice (Licence: CA 58847) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1855545) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2020-12-22 |