| NPI | 1619263084 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: VA 0401414379) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014259) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2015-10-20 |