| NPI | 1457487308 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PR 2674) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN20312) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2017-11-03 |