| NPI | 1962758029 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401413622) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401413622) |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2019-10-01 |