| NPI | 1013097781 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA 40066) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN 9294) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2007-07-08 |