| NPI | 1619124732 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401413430) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 10087) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2012-01-11 |