| NPI | 1073708418 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 10193) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NC 10193) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 10193) | |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2017-01-27 |