| NPI | 1174584304 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MO 2003021089) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 2003021089) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2018-04-09 |