| NPI | 1558351403 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 56736) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS035916) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2023-04-19 |