| NPI | 1689676025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401411741) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401411741) |
| 1223G0001X Dentist, General Practice (Licence: NY 050886-1) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2018-04-12 |