| NPI | 1093832560 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN 14428) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 3207) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2013-06-26 |