| NPI | 1376524652 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN 9385) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901018629) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2012-07-09 |