| 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 |