| NPI | 1467660860 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 25003) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019446) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2018-10-01 |