| NPI | 1336376847 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AR 3808) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8774) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2011-10-03 |