| NPI | 1467502104 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60220364) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 8827) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2019-07-25 |