| NPI | 1710196472 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 8375) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 8375) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401416319) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2018-09-27 |