| NPI | 1154557197 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IA 09012) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 25847) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2013-09-12 |