| NPI | 1003993445 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D-4108-PD) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00011112) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-04-22 |