| NPI | 1114901428 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: AZ D008574) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 56309) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2012-11-06 |