| NPI | 1780922187 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401413845) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.029300) |
| Enumeration Date | 2013-01-21 |
| Last Update Date | 2020-11-23 |