| NPI | 1518233550 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: GA DN014759) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: OH 30.023855) |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2014-07-24 |