| NPI | 1659637593 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO 00202498) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020478) |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2015-09-10 |