| NPI | 1003218629 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KS 60880) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2011030940) |
| 122300000X Dentist (Licence: OH 30.023393) | |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2015-05-24 |