| NPI | 1528415049 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2016024011) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61249) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2016024011) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KS 61249) | |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2016-08-18 |