| NPI | 1659693570 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: ZZ 1150654) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ZZ 3624692) |
| Enumeration Date | 2010-02-19 |
| Last Update Date | 2010-02-19 |