| NPI | 1417107616 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: KY 861) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8414) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2016-05-18 |