| NPI | 1013328129 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: FL 20420) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL 20420) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TX 29255) | |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2020-04-16 |