| 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 |