| NPI | 1962747469 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: AL ST00043) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 28561) |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2019-07-12 |