| NPI | 1215276399 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 29968) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020868) |
| Enumeration Date | 2013-02-08 |
| Last Update Date | 2014-08-21 |