| NPI | 1104252709 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NM DD3972) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NM DD3972) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2020-06-26 |