| 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 |