| NPI | 1376190074 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: LA 7018) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 7018) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2019-08-27 |