| NPI | 1073983896 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: GA DN0152258) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D13386) |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2018-03-01 |