| NPI | 1306151626 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO 00201834) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN18641) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2022-05-19 |