NPI | 1396123030 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE.61045280) |
Additional Taxonomies | 122300000X Dentist (Licence: SC 9245) |
122300000X Dentist (Licence: CA 65090) | |
1223P0221X Dentist, Pediatric Dentistry (Licence: OR D11196) | |
Enumeration Date | 2015-05-14 |
Last Update Date | 2020-05-13 |