| NPI | 1497091367 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NV S6-168) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 6328) |
| Enumeration Date | 2012-12-21 |
| Last Update Date | 2019-06-17 |