| NPI | 1265695597 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 8908) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 049006) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2019-04-15 |