| NPI | 1609200054 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN20729) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DRP1183) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2019-07-22 |