| NPI | 1730375064 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2010015177) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6697) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2010-06-16 |