| NPI | 1922490333 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN014966) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA DN014966) |
| Enumeration Date | 2015-02-21 |
| Last Update Date | 2022-07-21 |