| NPI | 1003807249 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA ds036541) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA ds036541) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2017-04-03 |