| NPI | 1659576668 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 841) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8494) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2010-03-02 |