| NPI | 1003177106 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OR D11478) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 8207) |
| 1223G0001X Dentist, General Practice (Licence: SC 8207) | |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2023-03-28 |