| NPI | 1881015691 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 9355) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9355) |
| Enumeration Date | 2013-12-20 |
| Last Update Date | 2022-07-21 |