| NPI | 1902213465 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MO X183076005) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO X183076005) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2014-07-16 |