| NPI | 1508985813 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401412581) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901019450) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 050652) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2011-01-07 |