| NPI | 1154848984 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 942) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 8456) |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2018-03-17 |