| NPI | 1063561553 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 4819) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ 4819) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ 4819) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 4819) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2023-03-21 |