| NPI | 1871687046 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 6404) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 6404) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2015-01-16 |