| NPI | 1629089651 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 005611) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 5611) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2012-11-20 |