| NPI | 1700266236 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 10082) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 10082) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2018-11-26 |