| NPI | 1679635304 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN013629) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 051391-1) |
| Enumeration Date | 2006-12-16 |
| Last Update Date | 2012-08-24 |