NPI | 1992060834 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 8543) |
Additional Taxonomies | 122300000X Dentist (Licence: WV 4003) |
Enumeration Date | 2012-07-06 |
Last Update Date | 2017-05-09 |