| NPI | 1568623262 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2012019714) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 3675) |
| 122300000X Dentist (Licence: KY in progress) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2013-06-26 |