| NPI | 1477093201 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: ZZ 7729009) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ZZ 8567994) |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2017-02-27 |