| NPI | 1679517163 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 20030) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ 7086) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2007-07-08 |