| NPI | 1164653473 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AK 162) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK 1249) |
| Enumeration Date | 2009-08-04 |
| Last Update Date | 2009-10-29 |