| NPI | 1992261036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401416366) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA RFD000030) |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2019-02-13 |