| NPI | 1477532448 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 122300000X Dentist (Licence: TN DS0000004747) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TN 313) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2007-07-08 |