| NPI | 1225480742 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA DDS101458) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD4573) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2017-12-07 |