| NPI | 1306834676 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NM DD2707) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: NY 04805) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2012-06-29 |