| NPI | 1881912376 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 9446) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8904) |
| Enumeration Date | 2010-05-10 |
| Last Update Date | 2017-01-09 |