| NPI | 1205213295 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NC 10107) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 10107) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2018-10-23 |