| NPI | 1275898157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE60936263) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL 11598) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2022-10-03 |