| NPI | 1760675227 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401411415) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901017909) |
| Enumeration Date | 2007-08-19 |
| Last Update Date | 2014-05-08 |