| NPI | 1821472275 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 106153) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030219) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2021-06-08 |