| NPI | 1871506188 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 9001) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 9001) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2023-03-31 |