| NPI | 1073740114 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL 19561) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019027948) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2019-06-11 |