| NPI | 1255772497 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401414768) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC DGD.8264GD) |
| 122300000X Dentist (Licence: VA 0401414768) | |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2019-01-10 |