| NPI | 1962754358 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60310679) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 34289) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN.00204868) | |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2025-01-08 |