| NPI | 1275880742 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: FL DN19651) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL DN19651) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2015-07-28 |