| NPI | 1730511148 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: OR D10773) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN20329) |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2019-05-02 |