| NPI | 1871871699 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 6778) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6778-15) |
| 122300000X Dentist (Licence: MI 2901020152) | |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2020-11-12 |