| NPI | 1942565023 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 8103) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN20661) |
| 1223G0001X Dentist, General Practice (Licence: SC 8103) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2019-09-12 |