| NPI | 1336683770 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: OH 30.025943) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9759) |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2020-06-22 |