NPI | 1487628053 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2011017345) |
Additional Taxonomies | 122300000X Dentist (Licence: NE 6537) |
Enumeration Date | 2006-02-13 |
Last Update Date | 2020-02-12 |