| NPI | 1477567154 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D8776) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA 20808) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2020-06-15 |