| NPI | 1396044517 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: WA DE60481607) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901020349) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2014-07-28 |