| NPI | 1174942122 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WY 1507) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61240) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 61240) | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2018-10-30 |