| NPI | 1801075668 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2015014907) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 0520991) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2015-06-30 |