| NPI | 1265507693 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PR 2759) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR 2759) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2022-07-11 |