NPI | 1659543890 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN014581) |
Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020343) |
Enumeration Date | 2008-03-27 |
Last Update Date | 2020-12-01 |